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Pathological Assessment of Men with Grade Group 2 Prostate Cancer.

Anika Jain1, Lawrence Kim2,3, Manish I Patel2,3,4

  • 1Department of Urology, Western Sydney Local District, Granville, NSW, Australia. anikajain2525@gmail.com.

The World Journal of Men'S Health
|September 30, 2024
PubMed
Summary

A new strategy, Strategy 8, effectively identifies men with Grade Group 2 prostate cancer (PC) at high risk for disease upgrading and adverse outcomes. This approach aids in treatment decisions for localized PC.

Keywords:
Active surveillanceGrade group 2PathologyProstate cancerProstatic neoplasmsWatchful waiting

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Area of Science:

  • Urology
  • Oncology
  • Pathology

Background:

  • Localized prostate cancer (PC) has multiple treatment options, but intervention timing for Grade Group (GG) 2 disease remains debated.
  • Identifying men with GG2 PC at risk for disease progression or adverse pathological outcomes is crucial for personalized treatment strategies.

Purpose of the Study:

  • To develop and evaluate strategies for identifying men with GG2 PC who are at risk of pathological upgrading and adverse outcomes.
  • To inform treatment decisions for localized GG2 PC.

Main Methods:

  • Retrospective analysis of 243 patients with GG2 PC treated with radical prostatectomy (2015-2021).
  • Exclusion of patients on active surveillance or with prior treatments (biopsy, hormonal, radiation therapy).
  • Analysis of clinicopathological data, including prostate-specific antigen (PSA) and Prostate Imaging Reporting and Data System (PI-RADS) scores.

Main Results:

  • PSA and PI-RADS scores were significant predictors of upgrading.
  • For composite poor outcomes, PSA, PI-RADS, extraprostatic extension, seminal vesicle invasion, positive biopsy cores, and Gleason pattern 4 volume were significant.
  • Strategy 8 (PI-RADS 5, >10% Gleason pattern 4, or >3 positive cores) demonstrated the highest association with identifying men with upgrading and poor outcomes.

Conclusions:

  • Strategy 8 is a valuable tool for treatment decision-making in men with GG2 PC.
  • Further validation of Strategy 8 is recommended to confirm its clinical utility.